Background and aims Various techniques have been described in anaesthesia for lower abdominal and orthopaedic surgeries. Continuous epidural anaesthesia has advantages over general anesthesia and has been the cornerstone for such surgeries. Difficult neuraxial blockade has always been a challenge for anaesthesiologists. A novel technique was used in few patients where it was difficult or very risky to secure catheter in lumber epidural space.

Methods Twelve cases are described here, which had predictors for difficult neuraxial blockade. One patient had subdural haematoma and developed features of severe obstructive inguinal hernia within few hours. Five patients had extradural haematoma and were provided conservative treatment. These patients were operated for femur interlocking. Six patients had ankylosing spondylitis and were scheduled for femur and tibial plating. All the above patients had various comorbid conditions and the author, although very experienced, anticipated the traditional inter-laminar approach either difficult because of abnormal anatomy or too risky if inadvertent dural puncture occurred. He successfully secured epidural catheter via caudal space. The technique will be described during the conference.

Results In all the cases,the epidural catheter was successfully secured in epidural space and position of tip confirmed. Surgical anesthesia was achieved and case conducted without any morbidity in all cases.

Conclusions Continuous epidural anaesthesia in difficult scenarios always constitutes a challenge for anaesthesiologists. It is recommended to use the author’s technique to manage cases effectively without any morbidity and mortality.